Page 31 - IRS Employer Tax Forms
P. 31

CORRECTED (if checked)
            PAYER’S name, street address, city or town, state or province, country, ZIP    1 Rents  OMB No. 1545-0115
            or foreign postal code, and telephone no.
                                                             $                    2020              Miscellaneous
                                                             2 Royalties                                    Income

                                                             $                   Form 1099-MISC
                                                             3 Other income      4 Federal income tax withheld  Copy B
                                                             $                   $                       For Recipient
            PAYER’S TIN             RECIPIENT’S TIN          5 Fishing boat proceeds  6 Medical and health care payments


                                                             $                   $
            RECIPIENT’S name                                 7 Payer made direct sales of  8 Substitute payments in lieu of
                                                              $5,000 or more of consumer    dividends or interest  This is important tax
                                                              products to a buyer                      information and is
                                                              (recipient) for resale  $                being furnished to
            Street address (including apt. no.)              9 Crop insurance proceeds  10 Gross proceeds paid to an    the IRS. If you are
                                                                                  attorney               required to file a
                                                             $                   $                    return, a negligence
                                                                                                         penalty or other
            City or town, state or province, country, and ZIP or foreign postal code  11  12 Section 409A deferrals  sanction may be
                                                                                                       imposed on you if
                                                                                                          this income is
                                                                                 $                    taxable and the IRS
            Account number (see instructions)  FATCA filing    13 Excess golden parachute    14 Nonqualified deferred    determines that it
                                           requirement        payments            compensation             has not been
                                                                                                              reported.
                                                             $                   $
                                                            15 State tax withheld  16 State/Payer’s state no.  17 State income
                                                             $                                       $
                                                             $                                       $
           Form 1099-MISC     (keep for your records)    www.irs.gov/Form1099MISC  Department of the Treasury - Internal Revenue Service
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